Omega-3 fatty acids plus rosuvastatin improves endothelial function in South Asians with dyslipidemia

Figures & data

Figure 1 Study design: An open-label, randomized cross-over study. Group 1 represents patients starting with rosuvastatin plus omega-3 PUFAs, Group 2 represents patients starting with rosuvastatin only.

Abbreviations: Ro, rosuvastatin; Omega-3 PUFAs, Omega-3 polyunsaturated fatty acids.

Figure 2 Average endothelial dependent vasodilation percentage (EDV%) for groups 1 and 2 during each visit. Group 1 represents patients starting with rosuvastatin plus omega-3 PUFAs, Group 2 represents patients starting with rosuvastatin only. Data represent mean per group ± SE.

Notes: *indicates statistical significance difference of average EDV% between each visit by Wilcoxon test.

Figure 3 Average endothelial independent vasodilation percentage (EIV%) for groups 1 and 2 during each visit. Group 1 represents patients starting with rosuvastatin plus omega-3 PUFAs. Group 2 represents patients starting with rosuvastatin only. Data represent mean per group ± SE.

Note: *indicates statistical significance difference of average EDV% between each visit by Wilcoxon test.

Figure 4 Lipid profile (including total cholesterol (TCh), high density lipoprotein (HDL), low density lipoprotein (LDL), and triglycerides (TG) for groups 1 and 2 at baseline (b), visit 1 (1), and visit 2 (2). Group 1 represents patients starting with rosuvastatin plus omega-3 PUFAs. Group 2 represents patients starting with rosuvastatin only. Data represent mean per group ± SE.

Note: *indicates statistical significance (by t test) between each visit.

Table 1 Baseline characteristics of the study subjects

Characteristics	Group 1 (n = 14)	Group 2 (n = 16)	P value
Age (years), mean (range)	51 (27–78)	52 (28–73)	NS
Gender: Male (n, %)	12 (86)	11 (69)	NS
Female (n, %)	2 (14)	5 (31)	NS
BMI, mean (kg/m^2)	27 ± 4.2	27.2 ± 4.7	NS
Dyslipidemia (n, %)	14 (100)	16 (100)	NS
Metabolic syndrome (n, %)	11 (79)	16 (100)	NS
CAD (n, %)	9 (64)	11 (69)	NS
Diabetes (n, %)	5 (36)	5 (31)	NS
HTN (n, %)	9 (64)	12 (75)	NS
Medications
ASA (n, %)	9 (64)	13 (81)	NS
Clopidogrel (n, %)	7 (50)	8 (50)	NS
Beta blocker (n, %)	9 (64)	9 (56)	NS
ACE inhibitor or ARB (n, %)	7 (50)	10 (63)	NS
Statin	4-week washout prior to randomization	4-week washout prior to randomization

Notes: Group 1 represents patients starting with rosuvastatin plus omega-3 PUFAs, Group 2 represents patients starting with rosuvastatin only. Data are presented as n or mean ± SD. Comparison between groups was done by chi-square test or t-test for age and BMI.

Abbreviations: NS, nonsignificant; BMI, body mass index; CAD, coronary artery disease; HTN, hypertension; ASA, aspirin; ACE, angiotensin-converting enzyme; ARB, angiotensin receptor blocker; PUFAs, polyunsaturated fatty acids; SD, standard deviation.

Table 2 Laboratory values

	Group 1			Group 2
	Baseline	1st visit	2nd visit	Baseline	1st visit	2nd visit
Total cholesterol (mg/dl)	191 ± 44	153 ± 37*	159 ± 35*	184 ± 40	159 ± 54	139 ± 31*
HDL (mg/dl)	42 ± 12	43 ± 13	44 ± 14	41 ± 15	40 ± 10	43 ± 15
LDL (mg/dl)	116 ± 37	88 ± 29*	96 ± 36	109 ± 31	91 ± 41	76 ± 24*
Triglycerides (mg/dl)	139 ± 57	91 ± 40*	99 ± 27*	137 ± 71	141 ± 71	103 ± 36*
Glucose (mg/dl)	124 ± 54	130 ± 62	112 ± 30	104 ± 24	108 ± 39	110 ± 38
Hemoglobin A1C (%)	7.0 ± 2.2	7.0 ± 2.2	6.6 ± 1.8	6.5 ± 1.1	6.3 ± 1.0	6.2 ± 1.0
Fibrinogen (mg/dl)	357 ± 72	348 ± 70	338 ± 68	357 ± 87	352 ± 70	333 ± 69
C-reactive protein (mg/l)	0.36 ± 0.41	0.3 ± 0.36	0.34 ± 0.46	0.4 ± 0.46	0.25 ± 0.23	0.19 ± 0.17
ESR (mm/hr)	16 ± 13	14 ± 12	12 ± 9	18 ± 13	14 ± 11	9 ± 9
Adiponectin (μg/ml)	8.63 ± 3.56	9.06 ± 4.75	8.98 ± 4.16	6.46 ± 4.4	6.22 ± 3.98	6.43 ± 4.6
BP Systolic (mmHg)	119 ± 10	112 ± 12	122 ± 16	127 ± 22	131 ± 17	132 ± 16
BP Diastolic (mmHg)	71 ± 7	69 ± 10	77 ± 9	75 ± 11	80 ± 10	77 ± 5

Notes: Group 1 represents patients starting with rosuvastatin plus omega-3 PUFAs. Group 2 represents patients starting with rosuvastatin only. Data are presented as mean ±SD. Statistically significant differences are indicated with an asterisk.

Abbreviations: HDL, high-density lipoprotein; LDL, low-density lipoprotein; ESR, erythrocyte sedimentation rate; BP, blood pressure; PUFAs, polyunsaturated fatty acids; SD, standard deviation.

Table 3 Assessment of endothelial function by brachial artery ultrasound

	Group 1			Group 2
Diameter (mm)	Baseline	1st visit	2nd visit	Baseline	1st visit	2nd visit
Resting	3.9 ± 0.6	3.7 ± 0.7	3.7 ± 0.7	3.7 ± 0.7	3.6 ± 0.6	3.1 ± 0.6
Post-ischemic maximum	3.9 ± 0.5	4.1 ± 0.7	3.7 ± 0.7	3.6 ± 0.8	3.6 ± 0.7	3.6 ± 0.7
Absolute EDV	−0.06 ± 0.13	0.41 ± 0.17*	0.007 ± 0.31	−0.09 ± 0.15	−0.006 ± 0.21	0.44 ± 0.31*
% EDV	−1.42 ± 3.27	11.36 ± 4.33*	0.59 ± 8.32	−2.49 ± 4.16	−0.66 ± 6.44	14.73 ± 10.77*
Post-nitroglycerine	3.9 ± 0.8	4.2 ± 0.8	4.0 ± 0.7	3.9 ± 0.6	4.0 ± 0.7	4.0 ± 0.8
Absolute EIV	0.11 ± 0.23	0.59 ± 0.26*	0.3 ± 0.27	0.33 ± 0.32	0.38 ± 0.36	0.77 ± 0.33*
% EIV	3.4 ± 7.67	17.37 ± 9.27*	8.71 ± 7.67	10.31 ± 9.62	11.02 ± 10.43	24.5 ± 11.94*

Notes: Group 1 represents patients starting with rosuvastatin plus omega-3 PUFAs. Group 2 represents patients starting with rosuvastatin only. Data are presented as mean ± SD. Statistically significant differences are indicated with an asterisk.

Abbreviations: EDV, endothelial-dependent vasodilation; EIV, endothelial-independent vasodilation; PUFAs, polyunsaturated fatty acids; SD, standard deviation.

Figure 5 Plotted results of endothelium dependent vasodilation percentage (EDV%) for each individual patient in group 1 and 2 between each visit. Group 1 represents patients starting with rosuvastatin plus omega-3 PUFAs, Group 2 represents patients starting with rosuvastatin only.